PEST Case 3: Know Your Final Destination
Profuse bleeding from a scalp wound with a large underlying haematoma.
He is not alert but responds to voice.
MAJOR LEARNING THEME IDENTIFIED: KNOW YOUR FINAL DESTINATION
The last thing anyone wants to see on a departures board next to their flight is the delayed sign. Disgruntled passengers and insurance claims for hours lost stuck in limbo in a warm building where alcohol is served 24 hours a day.
When the system runs smoothly, passengers turn up at the right airport, board at a prescheduled time and have a smooth and safe transition to their final destination.
Paediatric trauma care has been centralised within trauma networks to regional centres, ours being Queens Medical Centre, Nottingham. However, occasionally the complex paediatric trauma patient with multiple injuries arrives in our department – either because the paramedic crew feel they are too unstable to transfer to the trauma centre or because their injuries are initially underestimated and they are brought by car.
In these situations, it is important to perform a rapid assessment, screening for acutely life threatening injuries, provide stabilising treatment and then organise a time critical transfer to the regional trauma centre.
During this scenario, the team performed a systematic A to E assessment, recognised the immediate need to control haemorrhage from the head injury with direct pressure, secured the airway, gave IV resuscitation with fluid and blood and applied a pelvic binder to a suspected fractured pelvis.
Debrief discussions were focused on striking the balance between stabilising the patient but not performing investigations (such as FAST scan and CT head), which would only delay transfer to the regional trauma centre and would likely be repeated regardless.
The activation of our time critical transfer protocol was also discussed, the link to which can be found here.